Shadow Cells Research Articles

Patient Characteristics, Locations and Histopathological Features of Pilomatrixomas in Erzurum/Turkey

Aim: The aim of this study is to examine the patient characteristics, locations, presentations and histopathological features of pilomatrixomas in a group of patients. Materials and methods: We analyzed 41 patients that histopathologically diagnosed as pilomatrixoma in Erzurum Regional Training and Research Hospital between 2009 ad 2014, retrospectively. Results: Patient’s mean age was 30 years (age range: 3–78 years), with a female to male ratio of 26:15. There were 12 patients in the pediatric age group (<16 years). The average diameter of the lesion at presentation was 18.5 mm (range: 2–55 mm). A total of 36 out of 41 (87.8%) patients presented with solitary lesion, while 5 patient (12.2%) had two lesions. Most common location in our patient group was head and neck region and second most common location was limbs. The most common clinical presentation was a painless solitary skin lesion which was noticed incidentally. All cases more or less shared the same microscopic features of pilomatrixoma such as basophilic cells, eosinophilic shadow cells, calcification and foreign body type giant cells. Conclusion: Pilomatrixoma is not an uncommon benign lesion. It is more common in female gender, adult age group and at the head and neck region.

Seven-day ethanol administration influence on the rat brain histaminergic neurons

The purpose of the study is to clarify the effect of 7 days of ethanol administration upon brain histaminergic neurons in rats. Male Wistar rats were injected intraperitoneally (i.p.) with 20% ethanol/saline (0.85% NaCl) daily, over 7 days, whereas control rats were given saline. The animals were decapitated 24 h after the 7th injection and samples of hypothalamus were prepared for light and electron microscopy, accompanied by morphometry to examine the histaminergic neurons. It was found that ethanol administration gradually decreased the duration of alcohol-induced sleep and decreased the total amount of histaminergic neurons and the amount of histologically normal neurons, but increased the amount of hypochromic neurons and shadow cells. The histaminergic neuron bodies and nuclei decreased in size. The ultrastructural changes in histaminergic neurons demonstrated activation of their nuclear apparatus, both destruction or hypertrophy and hyperplasia of organelles, especially lysosomes. The histochemical examination revealed the activation of lactate dehydrogenase and acid phosphatase, and inhibition of NADH−, NADPhH, and succinate dehydrogenases. Following 7 days of ethanol administration, histaminergic neurons exhibit the structural signs of hyperactivity, which can be related to neuronal adaptation to the actions of ethanol, and increased behavioral tolerance to ethanol.

Urothelial Carcinoma with shadow cell, lipid cell and sebaceous (skin adnexal) differentiation: Clinicopathological and immunohistochemical study of 10 cases.

We discuss the histological and immunohistochemical features of 6 cases of urothelial carcinomas of lipid cell variant and 4 cases with shadow cell differentiation, one of which showed additionally sebaceous differentiation, one of which shows additional sebaceous differentiation, from our archive cases from the last 15 years. Conventional urothelial carcinoma (UC) was seen in all lipid cell variant cases, and micropapillary carcinoma was seen in 3. The ratio of the lipid cell component was between 10% and 40% in these 6 cases. Typical histologic features of the lipid cell variant include lipoblast-like cells with a notched nuclear appearance, abundant vacuoles, an eccentric nucleus, and pagetoid spread in some areas. GATA3 and pancytokeratin AE1/AE3 immunohistochemical staining were positive in all cases. Adipophilin was positive in various degrees in 5 of the 6 lipid cell variant cases but was also positive in the case with sebaceous differentiation. α-methylacyl-CoA racemase was positive in the lipid cell areas and negative or focal weakly positive in the conventional UC areas in 4 of the 6 cases. Vimentin, S-100 protein, and PAX8 were negative in the lipid cell component. Follow-up information was available for all cases with follow-up ranging from 6 to 84 months (mean, 34 months). Four patients died of the disease. One pT4 patient who had been followed up for 6 months lives with the disease, whereas another is disease free. In conclusion, the lipid cell variant is a rare UC variant that usually presents at an advanced stage, and tumor cells are histologically similar to lipoblasts, resemble sebaceous differentiation, and show positive immunohistochemical staining with adipophilin.

Structural trace of adaptation in motive nuclei of spinal cord of rats in hypokinesia and after physical loading in the recovery period

The purpose of this paper is to study the morphological changes of neurocytes in spinal cord of rats in hypokinesia and subsequent physical loading. Studies were performed on 55 laboratory rats of Wistar line. Materials of the research were the anterior horns of the gray matter of L5-S2 spinal segments. Preparations stained by Nissl and Viktorov were examined histologically. Hypokinesia was modeled following on the author’s technique. It was established that during prolonged hypokinesia in neurocytes of spinal cord of rats morphological changes in cell size and shape of the motor nuclei of all segments under study have been recorded. The number of hypochromic, hyperchromic destructively unchanged and hyperchromic destructively altered neurocytes increase; shadow cells appears, as well as cases of satellitosis and neuronophagia. Decrease in of albumen synthetical neurocyte function has been recorded. Physical loading of the average aerobic capacity leads to normalization of structural and functional state of neurocytes and enhances the reparative processes, as evidenced by a number of positive changes in morphometric parameters: increase in the number of normochromic neurocytes and decreasing the number of hyper- and hypochromic neurocytes with destructive signs, absence of pyknotic forms. Morphological parameters of neurocytes and their nuclei after physical loading of average aerobic capacity do not differ from those in the control group of intact animals. In neurocytes of this group of rats RNA concentration increases by 12.6% compared to animals after prolonged hypokinesia. Neurocytes of spinal cord of rats after prolonged hypokinesia develop significant morphological changes which are characterized by emergence of a significant number of hyperchromic neurocytes with signs of destructive changes and shadow cells, as well as and hypochromic neurocytes with signs of destructive changes, reduction in size and change of shape of perikaryons of neurocytes and their nuclei. Morphological changes of neurocytes after prolonged hypokinesia are accompanied by violations of biosynthetic processes, as evidenced by RNA decrease in the cytoplasm of efferent neurocytes of spinal cord of rats. Physical loading of average aerobic capacity leads to normalization of structural and functional state of neurocytes and promotes the reparative processes suported by positive changes in morphometric parameters.

Ghost cell lesions.

Ghost cells have been a controversy for a long time. Ghost cell is a swollen/enlarged epithelial cell with eosnophilic cytoplasm, but without a nucleus. In routine H and E staining these cells give a shadowy appearance. Hence these cells are also called as shadow cells or translucent cells. The appearance of these cells varies from lesion to lesion involving odontogenic and nonodontogenic lesions. This article review about the origin, nature and significance of ghost cells in different neoplasms.

English

We have studied a total of 59 skin adnexal tumors that has been reported for the past 10 years (2004 - 2014) in our hospital and we have documented that 7 cases of them are pilomatricoma. Features of myeloid metaplasia with extensive areas of calcification was observed with an old hematoma in only one case. Herewith a case of ancient/old pilomatricoma with extensive areas of calcification and ossification along with the formation of marrow elements is being presented. The lesion occurred in the shoulder region of a 16 year old female. Pilomatricoma (Calcifying epithelioma of Malherbe) is a tumor of hair follicle, composed of basaloid cells with squamous differentiation and formation of shadow cells.

A Case of Long-term Calcifying Epithelioma in the Neck Region

Calcifying epithelioma is a benign tumor derived from hair matrix cells. It more commonly involves the face and upper extremities in children and females and rarely occurs in individuals aged > 50 years. It can be detected at an early stage, with a typical clinical presentation of a hard mass under the skin, and can be surgically resected.Here we report the case of a 50-year-old male who presented with a scleroid-like tumor mass that could be palpated in his left neck. He had been aware of the tumor for approximately 30 years, and it had been progressively increasing in size. The tumor was located over the left sternomastoid muscle, was approximately the size of the tip of the fifth finger, and was hard and mobile. Two sharply demarcated oval opacities were demonstrated on computed tomography (CT), with the same CT value as that of bone. We diagnosed neck calcifying epithelioma and resected the tumor under local anesthesia. Histological examination revealed calcified material containing shadow cells with marginal ossification. The surface skin showed no apparent abnormalities. We report this rare case of neck calcifying epithelioma that went undiagnosed for more than 30 years and discuss the relevant literature.

Ovarian Basaloid Carcinoma with Shadow Cell Differentiation

So-called shadow cell differentiation (SCD) is typical for pilomatrixoma and other skin lesions with follicular differentiation, but it was rarely described also in some visceral carcinomas. We report a case of ovarian basaloid carcinoma with SCD. The tumor presented as a 14 cm ovarian mass in a 45-year-old woman, and therefore the adnexectomy and hysterectomy were performed. The tumor was of high stage. Multiple metastases were found in the liver, retroperitoneal and mediastinal lymph nodes, and the lung. Histologically, the tumor showed a pattern of high-grade basaloid carcinoma with numerous shadow cells. Extensive histologic examination did not reveal any glandular or preexisting teratoma component. Immunohistochemically, the tumor expressed markers of squamous cell differentiation, such as p63, cytokeratin 5/6, and high-molecular-weight keratin. Cytokeratin 7 and CA125 were positive in scattered cells of the lesion. Estrogen and progesterone receptor, vimentin, and p53 were negative. Beta-catenin showed nuclear and cytoplasmic positivity, indicating possible tumor proliferation/differentiation via Wnt signaling pathway. To our knowledge, SCD in basaloid carcinoma of the ovary was not described before. In addition to the description of the case, we review the literature on SCD in visceral carcinomas.

Odontogenic ghost cells: Realities behind the shadow….

Ghost cells are pale anucleate cells with homogeneous pale eosinophilic cytoplasm with very pale to clear central areas in place of a basophilic nucleus; which are seen in small clusters or large masses. Few odontogenic and nonodontogenic tumors exhibit the presence of these transparent or shadow cells as a typical feature. Many attempts have been made in the past by several investigators regarding the true characteristics of ghost cells in these lesions, in spite of which they seem to be mysterious. Here, we have made an attempt to clear the illusions and controversies surrounding ghost cells.

Pilomatricoma: an unusual presentation.

Dear Editor: Pilomatricoma, a slow-growing, benign adnexal tumor of the skin, originates from primitive cells of the hair matrix. It usually appears as a painless, firm, subcutaneous nodule, which adheres to the overlying skin. The overlying skin normally has a bluish discoloration. Although lesions with bullous changes on the overlying skin are very rare, they have been reported1,2,3. Herein, we report a case of bullous pilomatricoma to enhance the recognition and proper management of this variant, which represents a particular diagnostic challenge. An 18-year-old woman chiefly complained of a slightly tender, bullous skin lesion on her right upper back (Fig. 1A). Three months earlier, the lesion had appeared as a painless, firm nodule that enlarged with time beneath the skin. The bullous appearance was detected 1 month before her visit. The bulla was thick-walled, semitransparent, and sized 2.5×3 cm. A palpable mass was faintly noted inside the bulla. Systemic and laboratory examination results were normal. Preoperative bulla bisection revealed a firm central tissue core, surrounded by a sac and serous fluid (Fig. 1B). The lesion was totally excised and closed directly. The 1×2 cm mass inside the bulla was similar to a classical pilomatricoma: well demarcated, lobulated, and hard. On microscopic examination, we observed typical cells; anucleate keratinized basaloid cells (Fig. 2A, B). Endothelial cells of the dilated lymphatic channels were positive, on immunohistochemical staining, for CD34 and D2-40. Pseudocysts without endothelial cell lining were noted in the superficial dermis (Fig. 2C). The patient remained well without recurrence during follow-up for six months. Fig. 1 (A) Preoperative photograph showing the semi-transparent bulla, sized approximately 2.5×3 cm, with a whitish nodule inside, located on the right upper back of the patient. (B) Appearance inside the bulla: a firm central tissue core, within a serous ... Fig. 2 (A) Scanning view (1:1) demonstrating the whole architecture of the tumor with cystic change (H&E). Microscopic finding shows multiple dilated lymphatics above the typical nests of shadow cells and basophilic cells. (B) Arrow indicates ghost cells, ... Reports on bullous pilomatricoma are limited. To date, a total of 18 cases have been published1. Bullous pilomatricoma has a predilection for the shoulder and upper arm regions, predominantly affecting women aged 10 to 20 years. Lymphatic fluid fills the bulla-like space. It has been postulated that the pressure surrounding the hard core of the pilomatricoma induces obstruction of lymphatic vessels and congestion of lymphatic fluid, resulting in dilation of lymphatic vessels, with leakage of lymphatic fluid, and edema in the dermis surrounding the tumor, producing a bullous appearance2. Nearly all the cases of bullous pilomatricoma are formed by typical tumor nests-composed of shadow and basophilic cells-surrounded by a fibrotic capsule. Most cases present dilated lymphatic vessels and lymphedema in the superficial dermis2,3. Ghost, or shadow, cells are the most characteristic microscopic findings in pilomatricoma cases. They have distinct cell borders, with eosinophilic cytoplasm and a central clearing, representing the outline of an absent nucleus. Commonly, there is an associated foreign-body multinucleated giant-cell reaction and fibrosis with calcification; hence, this lesion was originally described as calcifying epithelioma of Malherbe. As for the classical pilomatricoma, surgical excision is the treatment of choice because this lesion does not regress spontaneously. The prognosis is excellent, without reported recurrences or malignant changes after excision.

Pilomatricoma with a bullous appearance

fying epithelioma of Malherbe, is the most common adnexal tumour in children and young adults. It typical­ ly occurs on the head, neck or upper limb. Here, we report a case of bul­ lous variant of pilomatricoma. A male adult presented a firm nodule covered by a sequent bulla on the left shoul­ der. Pathological examination showed the tumour was composed of irregu­ larly shaped epithelial islands which in cluded two cell types: basophilic cells and eosinophilic shadow cells. No cel­ lular atypia or abnormal mitotic fig­ ures were observed. These findings were consistent with a diagnosis of pi­ lomatricoma. The bulla was attributed to lymphatic obstruction that resulted in the dilation of lymphatic vessels. Our pilomatricoma had the unusual fea ture of a cross­shaped, giant bulla measuring 10 cm × 5 cm overlying the tumour. To our knowledge, it was the largest bullous pilomatricoma in the literature. After surgical resection, there was no recurrence.

Panfollicular carcinoma or trichoblastic carcinoma with panfollicular differentiation?

Herein, we report two cases of a follicular neoplasm with panfollicular differentiation showing architectural and cytologic findings suggestive of a malignancy. Immunohistochemical analysis of β-catenin expression in the neoplasm showed nuclear and cytoplasmic immunoreactivity, with no reactivity in the transitional and shadow cells, consistent with β-catenin expression of pilomatrical tumors. Staining for BerEp4 was positive at the periphery of both neoplasms, suggesting germinative differentiation of the neoplastic cells, whereas staining for the follicular stem-cell marker PHLDA-1 (TDAG51) showed strong focal expression in the tumor cells of both cases. Given these findings, these neoplasms show features of both panfollicular neoplasms and basal cell carcinoma with panfollicular/matrical differentiation. These are the first cases of this neoplasm reported to date. More reports are needed to assess their malignant potential.

English

It is an uncommon, harmless, skin lesion derived from hair follicle. Key diagnosis is identification of “densely stained basophilic cells and shadow cells”. Complete surgical excision is the treatment with rare chance of complication.

Agminated pigmented matricoma: a case of a unique tumor with a multifocal appearance composed of neoplastic matrical cells with a significant component of melanocyte

Matricoma is benign follicular neoplasm with the same constituent cells as pilomatricoma but with a different silhouette. Matricoma consists mostly of solid aggregations of matrical cells, as opposed to pilomatricoma, which is often a cystic lesion. We herein describe a case of agminated pigmented matricoma. A 27-year-old Japanese man visited our hospital complaining of three separate, pigmented, firm and sessile nodules on the back. Histopathologic examination revealed mostly solid aggregations of matrical and supramatrical cells located mainly within the dermis and the upper part of the subcutis. Shadow cells were present mostly within the aggregations. At higher magnifications, occasional indication of inner sheath differentiation, in addition to differentiation toward hair in the form of shadow cells, could be discerned in the center of the aggregations. The matrical and supramatrical cells within the aggregations were relatively uniform in size and shape, and contained several mitotic figures. Heavily pigmented melanocytes were present within the aggregations of matrical and supramatrical cells, and heavily pigmented melanophages were found in adjacent stroma. Pigmentation is a rare event in benign and malignant adnexal tumors, and to our knowledge, no similar case has been reported.

Pilomatrix Carcinoma

Pilomatrixoma is a common benign neoplasm of children and young adults with a female predilection. In contrast, its malignant counterpart, pilomatrix carcinoma is a rare neoplasm of older adults with a male preponderance. Pilomatrix carcinomas are locally aggressive with a tendency to recur. We report a case of a 44-year-old male who presented with an enlarging soft tissue tumor on the right upper back. Histology revealed an asymmetric, poorly circumscribed, lobulated neoplasm located deeply in the dermis with infiltration into the underlying subcutaneous tissue. The tumor was comprised of basaloid cells containing vesicular nuclei, prominent nucleoli, scant cytoplasm, and brisk mitotic activity. A focus of basaloid cells transitioning to shadow cells with central keratinized material and tumor necrosis was also present. The diagnosis of a pilomatrix carcinoma was rendered. Considering the infiltrative nature of this neoplasm with perineural and intramuscular invasion, the patient underwent 3 surgical excisions before it was completely removed.

Malignant pilomatricoma with multiple bone metastases in a dog: Histological and immunohistochemical study

An eleven year-old mongrel dog was referred with a history of left forelimb lameness and an ulcerated mass on the neck. Histologically, the cutaneous neoplasm revealed cystic lobules composed of basaloid cells with abrupt transition to central keratotic material, containing pycnotic and shadow cells. Approximately 3 months after primary diagnosis, a lesion of the cortical bone on the left humerus was observed using X-ray. Samples obtained from the humerus were processed for histopathological examination and the neoplastic tissue was observed to be similar to the type identified in the neck. Based on these findings, the tumor was diagnosed as a malignant pilomatricoma (MP) with bone metastasis. MP is a rare skin tumor that originates from hair matrix cells. To date, only nine reports have been presented in dogs. In the present study, we discuss the cytological and histological patterns of MP, confirmed by immunohistochemistry using β catenin antibody.

An unusual presentation of pilomatrixoma

The case reported here is an 18 year old male. He complained of a painless lump located on the left cheek over the anterior surface of masseter muscle for last 2 years. An early diagnosis of sebaceous cyst was made. Excision was performed and histopathological findings revealed pilomatrixoma. Pilomatrixoma is an uncommon, harmless, skin lesion derived from hair matrix cells. It is composed of an epithelial component of the most proximal portion of hair follicle. It is most often diagnosed in young children but may also affect adults. Single skin coloured or purplish lesions arise on the head and neck, but they may occur at any site. The key to diagnosis is identification of darkly stained 'basophilic cells' and 'shadow cells'. Calcium deposits are found in most of the lesions. Complete surgical excision is the treatment with rare chances of complications.

Bullous pilomatricoma: A rare variant resembling bouncy ball

Pilomatricoma (pilomatrixoma) or calcifying epithelioma of Malherbe, is a tumor with differentiation toward hair cells, particularly hair cortex cells. It frequently presents as a firm, deep-seated nodule that is covered by normal skin. Bullous pilomatricoma is an unusual clinical variant. Reports on bullous variant of pilomatricoma is sparse, and only 17 cases have been reported world-wide until date out of which only two cases are reported from India. We present a report of a 17-year-old female with a solitary reddish semi-transparent blister over her right upper arm since 3 months resembling a bouncy ball. Histopathology revealed tumor nests of basophilic cells and eosinophilic shadow cells, which are consistent with pilomatricoma.

Proliferating pilomatricoma with no recurrence during a 3-year follow-up

Proliferating pilomatricoma is a proliferative variant of pilomatricoma. Although it is considered as a benign tumor, local recurrence may occur. We report a case of a 49-year-old Japanese man with 3-year history of an asymptomatic subcutaneous tumor in the nuchal area. Histological evaluation demonstrated a cystic lesion lined by a basaloid epithelium at the periphery and filled with eosinophilic cornified material containing shadow cells in upper part of the tumor, and multilobular proliferation of basaloid cells in association with small foci of shadow cells in the remaining part. Based on these findings, the diagnosis of proliferating pilomatricoma was made. No recurrence has been observed during a 3-year follow-up.

Beta-catenin expression in pilomatrix carcinoma with multiple visceral metastases in a dog

Beta-catenin is a protein initially identified as a submembrane component of the E-cadherin-mediated cell-to-cell adhesion system. It plays a role as a transcriptional factor in the wingless/Wnt signalling pathway. Beta-catenin has been associated with oncogenic activity in human benign and malignant pilomatrix neoplasms where the immunohistochemical profile of β-catenin expression displayed both nuclear and cytoplasmic staining in basaloid cells. In this study, an 8-year-old female Irish setter dog was examined because of the presence of skin nodules. Tissue biopsies from different nodules were obtained and histological examination suggested a diagnosis of pilomatrix carcinoma. The dog spontaneously died after 2 months and necropsy showed multiple metastases in the nasal cavity, lungs, heart, kidney, liver and colon. Routine histopathology of metastatic sites showed features consistent with the pattern of primary neoplastic nodules. Immunohistochemical detection of β-catenin was performed in both the primary tumour and the metastases. Beta-catenin expression was located in the nuclei, cytoplasm and membrane of squamoid cells and in the cytoplasm of basaloid cells, while shadow cells were completely negative. To the best of our knowledge, these data represent the first report on the immunohistochemical expression profile of β-catenin in canine pilomatrix carcinoma.